Hemosiderin-laden Macrophages Research Articles

Intratumoral hemorrhage in vestibular schwannomas after stereotactic radiosurgery.

Vestibular schwannomas (VSs) are benign tumors of the cerebellopontine angle that are typically managed with stereotactic radiosurgery (SRS). Intratumoral hemorrhage (ITH) of VSs is a rare occurrence that results in worsening vestibular and new cranial nerve deficits. Few reports have described the management and outcomes of this entity after SRS. To further delineate the incidence and impact of this event, the authors performed a retrospective review of their VS SRS patients at a single center. Between 1987 and 2022, 2058 patients with VSs underwent Gamma Knife radiosurgery (GKRS) at the University of Pittsburgh Medical Center. The authors performed a review of the prospectively maintained VS database at their center to identify patients with ITH. The presentation, management, and clinical and imaging outcomes of the patients are reported. A total of 1902 VS patients had sufficient clinical and imaging follow-up data. Five Koos grade III (n = 1) and IV (n = 4) VS patients developed ITH after GKRS, resulting in a cumulative incidence rate of 0.26%. The age at presentation ranged from 62 to 79 years, and 3 patients were male. The time from VS diagnosis to GKRS ranged from 1 to 13 months, and the time from GKRS to ITH ranged from 2 to 130 months. Three patients had bleeding risk factors. One patient required urgent surgical intervention due to the ITH volume, while the other 4 patients were initially observed. Three patients remained stable and required no delayed intervention; 1 patient required delayed resection because of symptom progression and hemorrhagic expansion. Histopathological analysis revealed multiple fragments of S-100-positive cells, hemorrhage, and hemosiderin-laden macrophages. At last follow-up, 4 patients had clinically improved and 1 patient remained stable. ITH after VS radiosurgery is a rare phenomenon with a cumulative incidence rate of 0.26% in this series. Patient-tailored management in the form of observation or resection is based on patient presentation, acuity, and ITH size.

Diffuse Alveolar Hemorrhage: A Rare Underlying Disease in a Child with Chronic Respiratory Symptoms

Background: Diffuse lung disease (DLD), conventionally known as interstitial lung disease (ILD), encompasses a spectrum of diseases involving the pulmonary parenchyma with impairment of gaseous exchange. Most of the diseases under DLD have similar presentations, but appropriate investigations can delineate the exact disease. Diffuse alveolar hemorrhage (DAH) is one of the diseases under this umbrella group of DLD. Clinical Description: A 3-year-old girl suffering from persistent breathlessness and intermittent hypoxic exacerbations over 1 year, presented to us with acute respiratory worsening. She was underweight with stunting and had severe pallor. She had received blood transfusions in previous hospitalizations. Chest-X-ray shows reticular opacities, with High Resolution Computed Tomography (HRCT) chest showing bilateral diffuse ground glass opacities involving all lobes with the prominent pulmonary artery. The broncho-alveolar lavage showed hemosiderin-laden macrophages, thereby confirming alveolar hemorrhage. Antinuclear antibody was positive, though double-stranded DNA and Anti-neutrophil cytoplasmic antibody were negative. The child was thus diagnosed with a case of DAH, probably, immune mediated. Management: The child was treated with supportive care, including oxygen, intravenous fluids, antibiotics, and packed red cell transfusion. Even after improvement in hemoglobin, oxygen dependency persisted. The child was then administered Intravenous Immunoglobulin and prednisolone, to which the child showed a response with gradual weaning off oxygen. Conclusions: In any child presenting with persistent respiratory symptoms, especially exercise intolerance, over a prolonged period with intermittent hypoxic exacerbations, a pediatrician should consider diagnoses beyond infections and multitrigger wheezing. Such manifestations, particularly if associated with failure to thrive, may be due to DLD. DAH, a rare form of DLD, may be a possibility in such children.

219 ISOLATED CORONARY OSTIAL STENOSIS DUE TO RECURRENT AORTIC WALL THROMBOSIS

Abstract Background Coronary ostial lesions are a rare entity and isolated coronary ostial stenosis is even less frequent. Diffuse coronary artery atherosclerosis is the main cause for the non-isolated stenosis, based on old post-mortem series and histological analysis of tissue removed during atherectomies. Case presentation A 49-year-old woman suffering from mild non-familial hypercholesterolemia reported to her family physician repeated episodes of chest pain related to exercise. During a cardiological outpatient evaluation, 12 lead electrocardiogram (ECG) and echocardiography turned out normal. During a stress test she had recurrent chest pain coupled with ECG ischemic changes (diffuse ST segment elevation). She was immediately referred to the emergency department where the ECG was back to normal and the troponin dosage within normal range. Coronary angiography was performed: non-selective cannulation revealed some irregularities of the aortic wall profile at the level of the right coronary ostium, with inability to visualize the right coronary artery. The selective cannulation of the left main coronary artery (LMCA), left anterior descending (LAD) and left circumflex branches showed a critical ostial stenosis at the origin of the LMCA without any other relevant lumen restriction, in a left-dominant pattern of coronary circulation. A suspicion of LAD dissection was raised when a laminar flux was observed at its origin. At the end of the procedure, the patient suddenly collapsed. The recorded rhythm was initially bradycardia, evolving to episodes of ventricular tachycardia for which multiple shocks were applied. Despite the resuscitation efforts, the patient never recovered. Autopsy was performed at the local hospital. At gross analysis, a non-uniform pale-tan thickening at the level of the sino-tubular junction was evident with involvement of both the right and left coronary ostia. Histological examination allowed to ascribe the thickening to recurrent thrombosis, without any underlying inflammatory process at the level of the aortic wall and with only minimal atherosclerotic plaques. No coronary artery dissection nor significant stenosis was present in all the coronary tree. Regarding the ventricular myocardium, one focus of replacement-type fibrosis was identified at subendocardial level in the infero-septal wall coupled with a small spot of loose connective tissue rich in hemosiderin-laden macrophages in the same region, consistent with an area of subacute ischemic damage. Conclusion Several series reported a higher frequency of isolated coronary ostial stenosis in women versus men. In fact, female sex along with hypertriglyceridemia have been recognized as independent risk factors for ostial lesions. The case herein reported highlights the diagnostic relevance of the autopsy investigation together with clinicopathological correlation, particularly in cases where the definite diagnosis can't be achieved in vivo.

RADT-33. INTRATUMORAL HEMORRHAGE IN VESTIBULAR SCHWANNOMAS FOLLOWING GAMMA KNIFE STEREOTACTIC RADIOSURGERY

Abstract INTRODUCTION Intratumoral hemorrhage (ITH) is a rare occurrence in vestibular schwannomas (VS) resulting in worsening vestibular and cranial nerve deficits. Scarce data described the occurrence, management, and outcomes of ITH after stereotactic radiosurgery (SRS). OBJECTIVE The aim of this study is to delineate the incidence, presentation, management, and outcomes of ITH in VS patients following SRS. METHODS A total of 2058 patients with VS underwent Gamma Knife radiosurgery (GKRS) at the University of Pittsburgh Medical Center between 1987 and 2022. The authors identified patients with ITH. Their presentation, management, clinical, and imaging outcomes are reported and analyzed. RESULTS A total of 1902 VS patients had sufficient clinical and imaging follow-up data. Five Koos III (n = 1) and IV (n = 4) VS patients developed ITH after GKRS, resulting in a cumulative incidence rate of 0.26%. The age at presentation ranged from 62 to 79 years, and 3 of the patients were males. The time from VS diagnosis to GKRS ranged from 1-13 months, and the time from GKRS to ITH ranged from 2-130 months. Three patients had bleeding risk factors. One patient required urgent surgical intervention due to the ITH volume, while the other four patients initially were observed. Three remained stable and required no delayed intervention. Histopathological analysis revealed multiple fragments of S-100–positive cells, hemorrhage, and hemosiderin-laden macrophages. At last follow-up, 4 patients had clinically improved, and one remained stable.ConclusionVS ITH following SRS is a rare complication with a cumulative incidence rate of 0.26%. Patient-tailored management is vital based on patient presentation, acuity, and ITH size and characteristics.

8880 Recurrent Endometriosis-Associated Massive Hemorrhagic Ascites: A Case Report and Literature Review

<h3>Study Objective</h3> To discuss the presentation, pathophysiology, and management of large-volume endometriosis-related ascites. <h3>Design</h3> Case report and literature review. <h3>Setting</h3> University-based teaching hospital. <h3>Patients or Participants</h3> A 31-year-old with cyclic pelvic pain presented with new-onset hemorrhagic ascites up to 6L in volume requiring recurrent paracentesis. <h3>Interventions</h3> Initial ultrasound imaging (Figure 1) revealed large volume ascites, normal uterus, and normal ovaries. Computed tomography scan revealed a large amount of ascites with a normal-appearing liver. Paracentesis revealed hemosiderin laden macrophages and no evidence of malignancy or bacterial growth. The patient's medical and hepatologic workup was unremarkable. After undergoing two additional paracentesis procedures, she underwent diagnostic laparoscopy and peritoneal biopsies. Findings included stage 4 endometriosis with posterior cul-de-sac disease, right adnexal and large bowel disease, and diaphragmatic disease (Figure 2). <h3>Measurements and Main Results</h3> The patient was started on high-dose oral progestins postoperatively. Thereafter, she noted symptom improvement and less frequent paracentesis, but stopped therapy due to side effects. She was started on Elagolix and add-back therapy with no recurrence of ascites over one month of follow-up. Large-volume endometriosis-associated ascites is rare, usually recurrent, and thought to be due to massive ovarian transudate plus altered lymphatic drainage¹. Symptoms may mimic those of an ovarian malignancy. Associated CA-125 levels vary and do not correlate with the presence of ascites^2,3. Additionally, 38% of patients present with pleural effusion². Suppressive therapy with gonadotropin-releasing hormone (GnRH) agonists temporarily prevents ascites recurrence, but medical management regimens and outcomes vary^1,3,4. Surgical management of endometriosis without bilateral salpingo-oophorectomy (BSO) is associated with a recurrence rate of over 50%, while BSO is curative¹. <h3>Conclusion</h3> Clinicians should consider endometriosis in the workup for patients presenting with pelvic pain and recurrent large-volume hemorrhagic ascites after ruling out ovarian malignancy. Suppressive therapy with high-dose progestins or GnRH agonists/antagonists may improve symptoms and reduce the risk of recurrent ascites, but rigorous studies are lacking.

8747 Excision of Endometriosis in a Postmenopausal Patient

<h3>Study Objective</h3> We seek to demonstrate endometriosis excision in a postmenopausal patient status post hysterectomy and explore the important clinical features of postmenopausal endometriosis. <h3>Design</h3> Case study. <h3>Setting</h3> Urban academic tertiary care center. <h3>Patients or Participants</h3> One postmenopausal female with history of biopsy proven endometriosis experiencing persistent pelvic pain and deep dyspareunia following prior total laparoscopic hysterectomy and endometriosis excision procedures. <h3>Interventions</h3> Exam under anesthesia, bilateral salpingo-oophorectomy, lysis of adhesions, excision of endometriosis, partial peritonectomy, and cystoscopy. <h3>Measurements and Main Results</h3> Intra-op findings included abundant filmy adhesions and focal hemorrhagic lesions, which appeared consistent with endometriosis. Pathology showed fibrous serosal adhesions and associated hemosiderin laden macrophages compatible with clinical impression of endometriosis, though classical findings of endometrial glands and stroma were absent. The patient reported near complete resolution of her prior symptoms following the surgery, without use of narcotic medication, and overall satisfaction with the procedure. <h3>Conclusion</h3> Endometriosis is an estrogen-mediated chronic inflammatory condition that is benign but has a significant impact on the quality of life of many people. Though symptoms are typically seen in premenopausal individuals, cases of postmenopausal endometriosis have also been shown and are estimated to account for roughly 1-5% of all cases. It is hypothesized that extra-ovarian estrogen production from adipose tissue or endometriosis implants may contribute to or drive these processes, but the precise mechanism and etiology is not well understood. Surgical management is particularly important for postmenopausal patients, especially those with endometriomas, given the increased association with malignancy. Here we present a case of a patient with postmenopausal endometriosis status post TLH who experienced significant symptom improvement following surgical treatment with bilateral salpingo-oophorectomy, partial peritonectomy, lysis of adhesions and excision of endometriosis lesions. More research is needed to fully understand the etiology, impact, and appropriate treatment options for postmenopausal endometriosis.

RECURRENT CATAMENIAL PNEUMOTHORAX: AND WE THOUGHT OUR CRAMPS WERE BAD

RECURRENT CATAMENIAL PNEUMOTHORAX: AND WE THOUGHT OUR CRAMPS WERE BAD

HEMOPTYSIS: A RARE PRESENTATION OF MALIGNANT PLEURAL MESOTHELIOMA

HEMOPTYSIS: A RARE PRESENTATION OF MALIGNANT PLEURAL MESOTHELIOMA

Histo-Pathological Evaluation of Breast Cancer after Neo-Adjuvant Chemotherapy

Background: A recent standardized therapeutic technique for the patients having advanced and large (bigger than two centimeters) breast cancer is neo-adjuvant chemotherapy. The gold standard is the histo-pathological assessment of carcinoma response. Methodology: In this research study, we performed the histo-pathologic evaluation of forty-four samples received in the pathology department over a period of one year from 1 July 2021 to 30 June 2022. Results: In this research study, we studied total forty-four patients with breast cancer. Average age of these females was fifty years. Average size prior CT was 56.140 centimeter square and post CT was 29.4 centimeter square. In this research work, complete pathologic response was shown by eighteen percent patients and incomplete response was shown by eighty-four percent patients. Conclusion: Changes in pattern of characterizations examined after the histo-pathological evaluation of tumor are dystrophic calcification, stromal hyalinization, regions of coagulated necrosis, reactive infiltration of lymphocytes, cellular fibrous tissue and hemosiderin laden macrophages. Keywords: Characterization, pathology, evaluation, neo-adjuvant chemotherapy, carcinoma, cancer, average.

Enhancing respiratory disease diagnosis by bronchoalveolar lavage in Kashmir: an audit of findings

ObjectiveTo study bronchoalveolar lavage (BAL) findings in various respiratory diseases in children in Kashmir India.DesignProspective observational study.SettingPaediatric department of the tertiary care hospital.PatientsChildren of both genders from 1 month to...

FNAC study of giant cell tumor of tendon sheath (localized tenosynovial giant cell tumor): Clinico-radiological correlation and cytopathological features.

Localized tenosynovial giant cell tumor (GCT) or giant cell tumor of tendon sheath (GCTTS), is a benign nodular lesion that arises from the synovium of the tendon sheath of the hands and foot. GCTTS is characterized by the presence of multinucleated giant cells and proliferation of synovial-like mononuclear cells. A clinical diagnosis of GCTTS is kept as a differential when a firm, nodular mass shows decreased signal intensity on both T1-and T2-weighted MR imaging. Treatment is usually marginal excision of the mass. It is a retrospective study, observed in the past 3 years at a tertiary care hospital. Those cases were included in the study in which histopathological confirmation was available or if clinico-radiological features were confirmatory of the diagnosis of GCTTS when correlated with cytological features. There was a total of 24 cases, out of which 16 were females and 8 males. The tumor was located in the upper limb in 21 cases and in 3 cases the tumor was present in the lower limb. In the upper limb, 18 cases were on the right side and three cases were on the left side. In the lower limb, 1 case was present on the left and 2 on the right side. The cytomorphology consisted of mononuclear stromal cells, multinucleated giant cells, and hemosiderin-laden macrophages in variable numbers. It is important to accurately diagnose and categorize giant cell-containing lesions because their prognosis depends on the exact categorization of the tumor.

Encephalic meningioangiomatosis in a cat.

Meningioangiomatosis (MA) is a rare proliferative meningovascular entity that has been described mainly in humans and dogs. Here we describe MA in a 13-y-old spayed female domestic shorthaired cat that died 5 d after acute change in behavior, open-mouth breathing, seizures, hyperthermia, and inability to walk. On MRI, the lesion appeared predominantly as extraparenchymal hemorrhage. Autopsy changes consisted of a dark-red, hemorrhagic plaque that expanded the leptomeninges and outer neuroparenchyma of the right piriform and temporal telencephalic lobes, chalky white nodules in the peripancreatic fat, and yellow fluid in the abdomen. Histologically, the lesion in the brain consisted of leptomeningeal thickening by spindle cells that effaced the subarachnoid spaces and extended perivascularly into the underlying cerebral cortex. Spindle cells were arranged as streams or whorls around blood vessels, and had slender eosinophilic cytoplasm and elongated nuclei with coarsely stippled chromatin and 1 or 2 distinct nucleoli. There was extensive hemorrhage, clusters of hemosiderin-laden macrophages, and mineralization throughout. Spindle cells had positive immunolabeling for vimentin. A striking MRI and gross feature in our case was the extensive hemorrhage associated with the MA lesion. Additional findings included suppurative pancreatitis with peritonitis and supraspinatus myonecrosis.

Cytopathological Findings in Bronchoalveolar Lavage from Patients with COVID-19

Information on cellular analysis of bronchoalveolar lavage (BAL) in patients with COVID-19 is limited. Some studies have described an increase in lymphocyte percentage or exuberant plasmacytosis. Some reports addressed the importance of molecular testing on BAL samples to confirm COVID-19 pneumonia, in clinically highly suspected patients with consecutive negative nasopharyngeal swab results. In addition to atypical lymphocytes in the peripheral blood, morphologic findings of atypical lymphocytes in BAL were also reported in a few patients. The objective of this study was to describe the cytopathic characteristics identified, any data presented here are descriptives and intended to trigger further research. Three general aspects have been evaluated in each sample: reactive changes, virus-related pathological changes, and differential leukocyte count. Seventeen samples were collected. All samples were negative for malignancy, with an inflammatory background, predominantly lymphohistiocytic in 5 samples, histiocytic in 9, and 3 with predominantly neutrophilic. Hemosiderin-laden macrophages were observed in 12/17. Nonspecific reactive cell changes were identified in 4 samples, including bronchial, alveolar, and reserve cell hyperplasia. Virus-related pathological changes were observed in 14 samples, such as loss of nuclear chromatin pattern, lymphocytes with atypical nuclei, nuclear and cytoplasmic inclusions, multinucleations in bronchial cells and macrophages, or multinucleated giant cells. The identification of multinucleated giant cells could represent a cytopathic effect induced by the virus, at the same time the nuclear clearance of pneumocytes as a possible direct effect. BAL is a procedure aimed at obtaining cells from the respiratory tract that can provide valuable and rapid information. It is important to collect and describe as many cytopathological findings as possible, which can provide relevant information for future studies.

Tumor-associated mononuclear cells in the tumor bed of triple-negative breast cancer associate with clinical outcomes in the post-neoadjuvant chemotherapy setting.

To evaluate the clinical role of tumor-associated macrophages, including foamy (FM) and hemosiderin-laden macrophages (HLM) in the tumor bed (TB) of triple-negative breast cancer (TNBC) post-neoadjuvant chemotherapy (NACT). We conducted a pathologic review of 129 women, diagnosed with TNBC between 2002 and 2016 at our institute. The residual cancer burden (RCB) was calculated. We estimated the percentage of tumor-infiltrating lymphocytes (TILs) in the core needle biopsy (CNB), and FM, HLM, and TILs (in TB) [the combined cells are designated as tumor-associated mononuclear cells (TAMNC)]. The information on patient demographics, chemotherapy regimen, recurrence-free survival (RFS), and overall survival (OS) was extracted from the medical records. Pathologic complete response (pCR) was achieved in 34.1% of the women. TILs (10% increment in CNB) only were associated with pCR in the multivariable analysis [odds ratio 1.04 (1.02, 1.06) (p = 0.0003)]. Immune cells associated with better OS included TAMNC (≤ 30%) [hazard ratio (HR) 4.32 (1.93, 9.66) (p = 0.0004)], and FM (0%) [HR 2.30 (1.06, 4.98) (p = 0.036)]. While increased HLM (10% increment) was statistically significant with HR 0.93 and 95% CI (0.88 to 0.98) (p = 0.0061), using a cutoff of 0%, HLM (0%: negative vs. ≥ 1%: positive) achieved only borderline significance with HR 2.05 (0.98, 4.31) (p = 0.058). Similarly, these immune cells were also associated with better RFS: TAMNC (≤ 30%) [HR 4.57 (2.04, 10.21) (p = 0.0002)], FM (0%) [HR 2.80 (1.23, 6.35) (p = 0.014)], and HLM (0%) [HR 2.34 (1.07, 5.11) (p = 0.03)]. TILs (in TB) were not associated with any clinical outcomes. Although TILs may play a role in the response to NACT, they may not be critical to the prognosis after NACT. Instead, FM and HLM may assume this role. More studies are warranted.

ANOTHER BLOODY PNEUMONIA? DIFFUSE ALVEOLAR HEMORRHAGE RESULTING FROM IDIOPATHIC THROMBOCYTOPENIC PURPURA

TYPE: Case Report TOPIC: Diffuse Lung Disease INTRODUCTION: Diffuse alveolar haemorrhage (DAH) is a rare life-threatening pulmonary bleeding manifestation of Idiopathic thrombocytopenic purpura (ITP). CASE PRESENTATION: A 74-year-old gentleman presented to the emergency triage with haemoptysis, worsening shortness of breath, and desaturation. X-ray and CT chest revealed opacifications suggestive of pulmonary haemorrhage. Platelet count was found to be 5,000/μL. Further history revealed he was recently weaned off his usual steroid dose for ongoing ITP. He was initiated on CPAP and received 1 platelet pool. Prednisolone dose was escalated to 1mg/kg once-daily with a stat dose of IVIG(1g/kg). His breathing improved with elevation of platelet count to 37,000/μL. Unfortunately, developed hypoxic respiratory failure again within next couple of days as his platelet count dropped down to 7,000/μL. He was started on eltrombopag along with a repeat platelet transfusion and another dose of IVIG(1g/kg). Clinico-radiological improvement was noted. Platelet count returned to normal by week 6 after admission. DISCUSSION: There is a poor correlation between the degree of thrombocytopenia and bleeding; however, platelet count <10,000/μL is associated with serious bleeding. Histopathologic findings in DAH vary from pulmonary capillaritis, bland hemorrhage to eventual development of diffuse alveolar damage, and hemosiderin-laden macrophages. Immunosuppressive agents are the mainstay of treatment. CONCLUSIONS: We reiterate to keep in mind the possible association between ITP and DAH in the appropriate clinical context. Reference 1: Ioachimescu, O.C. Diffuse alveolar hemorrhage: Diagnosing it and finding the cause. Clevel. Clin. J. Med. 2008 Reference 2: Newsome, B.R.; Morales, J.E. Diffuse alveolar hemorrhage. South. Med. J. 2011, 104, 269–274 DISCLOSURE: Nothing to declare. KEYWORD: diffuse alveolar haemorrhage, idiopathic thrombocytopenic purpura

Percutaneous Radiofrequency Ablation to Occlude the Thoracic Duct: Preclinical Studies in Swine for a Potential Alternative to Embolization

PurposeTo investigate the feasibility of percutaneous radiofrequency (RF) ablation to occlude the thoracic duct (TD) in a swine model with imaging and histologic correlation. Materials and MethodsSix swine underwent TD RF ablation. Two terminal (4 hours, 1 open and 1 percutaneous) and 4 survival (30 days, all percutaneous) studies were performed. Two 20-gauge needles were placed adjacent to the TD under direct visualization after right thoracotomy or under fluoroscopic guidance using a percutaneous transabdominal approach after intranodal lymphangiography. RF electrodes were advanced through the needles, and ablation was performed at 90°C for 90 seconds. Lymphangiography was performed, and the TD and adjacent structures were resected and examined microscopically at the end of each study period. ResultsFour of 6 subjects survived the planned study period and underwent follow-up lymphangiography. Two subjects in the survival group were euthanized early—1 after developing an acute chylothorax and 1 because of gastric volvulus 14 days after ablation. Occlusion of the targeted TD segment was noted on lymphangiography in 3 of the 4 remaining subjects (2 acute and 1 survival). Histology 4 hours after RF ablation demonstrated necrosis of the TD wall and hemorrhage within the lumen. Histology at 14 and 30 days revealed fibrosis with hemosiderin-laden macrophages replacing the ablated TD. Collagen degeneration within the aortic wall involving a maximum of 60% thickness was noted in 5 of the 6 subjects. ConclusionsPercutaneous RF ablation can achieve short-segment TD occlusion. Further study is needed to improve safety and demonstrate clinical efficacy in treating TD leaks.

Clinical and Pathological Findings of Suspected Cases of Peritoneal Endometriotic Lesions

Objective: The purpose of this study is to determine the clinical and pathological findings of suspected cases of peritoneal endometriotic lesions. Study Design: Cross-sectional/Observational study Place and Duration: Shaikhzaid women hospital larkana, From: Jan, 2021 to June, 2021 Methods: There were 88 females were presented in this study. Females were aged between 18-55 years. Informed permission was obtained before obtaining demographic information such as age, BMI, and symptoms. Included patients had confirmed peritoneal endometriotic lesions. All the suspected cases of peritoneal endometriotic lesion were underwent for biopsies. Numerous endometriotic biopsies were analyzed using mixed effects logistic regression in order to account for various patients and multiple endometriotic gland patterns. Pathological and clinical outcomes among cases were measured. We used SPSS 21.0 to analyze complete data. Results: Among 88 cases, 30 (34.1%) were aged between 18-28 years, 37(42.05%) were aged between 29-38 years and the rest were 21 (23.9%) were aged &gt; 38 years. Mean BMI of the females was 23.2±14.25 kg/m2. Dysmenorrhea was the most common symptoms found in 32 (36.4%) cases, followed by deep dyspareunia in 26 (29.5%) cases, chronic pelvic pain in 18 (20.5%) cases and painful defecation in 12 (13.6%) cases. Frequency of endometriosis was 40 (45.5%) by pathological findings. Majority was undiagnostic biopsies among 58 (65.9%) cases and diagnostic biopsies were among 30 (34.1%) cases. Among undiagnostic biopsies, chronic inflammation found in 18 (31.03%), dystrophic calcifications in 15 (25.9%) cases, hemosiderin-laden macrophages (HLM) in 13 (22.4%) cases, vascular proliferation 10 (17.2%) and adhesions were 10 (17.2%). HLM (P=0.002) and pseudodecidualization (P=0.03) were more often seen in diagnostic biopsies (P=0.05) as were blue/black clinical appearances (P=0.03). Conclusion: We found that individuals with a strong clinical suspicion of endometriosis show a variety of histologic abnormalities, with fewer than half satisfying current histopathologic criteria. Given the diverse histopathologic appearance, more study may be necessary, especially for lesions with primarily vascular characteristics. Keywords: Peritoneal Endometriotic Lesions, Symptoms, Endometriosis, Biopsy, HLM

Diagnostic significance of the histopathology of bone marrow macrophages in forensic autopsies

Forensic pathologists often encounter autopsies that require an assessment of antemortem general conditions (e.g., infection, metabolic disorders). To establish evaluation clues for such cases, we quantitatively examined macrophages and the general pathology of bone marrow in samples from 180 forensic autopsy cases of decedents with various conditions. Hematoxylin-eosin staining, Berlin blue staining, and immunostainings for CD163, CD138, and CD61 were performed. We determined the numbers per field (density) of total macrophages, swollen macrophages, macrophages with hemophagocytosis, and hemosiderin-laden macrophages. Each density was standardized by identifying its ratio to the total number of macrophages. The decedents' background data (cause of death, other pathological findings, postmortem interval, antemortem symptoms, and presence of resuscitation) were extracted. No correlations were found between the postmortem interval and the other decedent data, indicating that these data are not affected by postmortem changes. In the group in which inflammatory disease was the cause of death, there were significant elevations in the ratio of the swollen macrophage density to total macrophages. Significantly higher ratios of the density of swollen and hemophagocytic macrophages were observed in the group in which conditions with a prolonged agonal period were the cause of death. The group with a return of spontaneous circulation to resuscitation showed a significantly higher ratio of macrophage density with hemophagocytosis. This study provides the first statistical analysis focused on bone marrow histopathology in forensic autopsies. The results will be useful for elucidating causes of death and agonal-period conditions.

Interval appendicitis shows histological differences from acute appendicitis and may mimic Crohn disease and other forms of granulomatous appendicitis.

While patients presenting with clinical signs and symptoms of acute appendicitis (AA) often receive surgical intervention shortly after presentation, certain patients may instead receive non-operative management initially, with appendectomy later. The histology of such interval appendicitis (IA) has only been described in small series. Also, we have noticed a recent increase in the incidence of IA specimens at our institution. We identified appendectomy specimens in our department during 2018 with available haematoxylin and eosin slides and electronic clinical data, and evaluated multiple histological findings. Cases were then divided into AA and IA, based on clinical history (AA if the patient presented to the hospital within 1 week of symptom onset and underwent appendectomy within 48 h; IA if appendectomy was delayed at least 1 week). Changes between groups were compared. The cohort included 165 cases (125 AA, 40 IA). Findings significantly more common in AA included mucosal acute inflammation, mural acute inflammation and acute serositis. Findings significantly more common in IA included Crohn-like mural inflammation, mural fibrosis, goblet cell hyperplasia, granulomas, xanthogranulomatous inflammation, haemosiderin-laden macrophages and granulation tissue. The rate of IA in 2018 (24%) was noticeably higher than in previous years. Acute inflammatory changes are more common in AA but can remain present in IA. Mural fibrosis, serosal adhesions, haemosiderin-laden macrophages and granulation tissue suggest IA. Granulomas and xanthogranulomatous inflammation can also be seen in IA, and Crohn-like mural inflammation is not uncommon. These histological patterns can guide signout and prevent diagnostic errors, particularly when clinical information is unavailable.

Abstract PD11-04: A multi-feature AI-based solution for cancer diagnosis in breast biopsies: A prospective blinded multi-site clinical study

Abstract Objective This study aimed to clinically validate the performance of a multi-feature AI-based solution on detection of invasive versus in situ carcinomas and in situ ductal carcinoma high grade from atypical ductal hyperplasia/low grade DCIS compared to rigorous ground truth (GT) established by multiple blinded expert pathologists in breast biopsies. Design Performance of the AI solution was prospectively tested on breast biopsies from two medical institutions in different geographies. AI results were compared against the ground truth (GT) established by consensus of two subspecialist breast pathologists. The study endpoints were detection of invasive carcinoma (IDC, ILC) and DCIS/ADH, including differentiating between different DCIS grades and ADH. ADH and DCIS Low Grade were pooled together because of similar clinical management when diagnosed on a biopsy. Results Six pathologists participated in the study and reported on 436 breast biopsies (841 H&amp;E slides), including 156 invasive (including 31 rare subtypes), 135 DCIS/ADH and 145 benign diagnoses. The AI solution demonstrated high performance when compared with the GT with an AUC of 0.99 for the detection of invasive carcinoma (specificity and sensitivity of 93.6% and 95.5% respectively) and with AUC of 0.95 for the detection of DCIS/ADH. The AI solution differentiated well between subtypes/grades of invasive and in-situ cancers with an AUC of 0.97 for IDC vs. ILC and AUC of 0.92 for DCIS high grade vs. low grade/ADH, respectively. Only 11 (7%) cases had discrepancies on invasive diagnosis, 4 of these between invasive versus benign diagnosis encompassing one case on which the invasive component was only represented by rare lympho-vascular invasion, two cases of ILC (one with a diffuse pattern and the second in a case with granulomatous mastitis with multinucleated giant cells and hemosiderin-laden macrophages) and one rare case of tubular carcinoma surrounded by flat epithelial atypia and columnar cell lesions. Fifteen cases (11%) had discrepancies on DCIS/ADH diagnosis between the two specialist pathologists necessitating a third assessment by a specialist to establish GT. Six of these cases also necessitated a review on a multihead microscope to reach a consensus decision, since there was no majority even after 3 reviews. Conclusion This blinded multi-site study reports the successful clinical validation of a multi-feature AI-based solution in detecting and automatically imparting clinically relevant diagnostic parameters regarding invasive and in situ breast carcinoma, offering an important tool for computer-aided diagnosis in routine pathology practice. Citation Format: Anne Vincent-Salomon, Guillaume Bataillon, Alona Nudelman, Judith Sandbank, Anat Albrecht Shach, Lucie Thibault, Lilach Bien, Rachel Mikulinsky, Ira Krasnitsky, Ronen Heled, Chaim Linhart, Manuela Vecsler, Daphna Laifenfeld. A multi-feature AI-based solution for cancer diagnosis in breast biopsies: A prospective blinded multi-site clinical study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD11-04.